310229_INSPECTIONS_20171231

�I
NORTH CAROLINA
Department of Environmental Qual

F"
M
Type of Visit: 10 Comp ' cc Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 2 17 Arrival Time: Departure Time: 00 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: _
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
e% A 61-0L-I\
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 2603,6
Certification Number:
Longitude:
Swine
Wean to Feeder
Design Current
Capacity Pop.
2 Soo
WgM et Poultry
Non -La er
Mayer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oultr,
Layers
Design
Ca aci
Current
P.o .
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑----,
❑ NA
❑ NE
❑ Yes
��,,N�o """"
,%
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

Facili Number: '3 1 - 2 Date of Inspection: r
Waste Collection & Treatment �--��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L ,Kb LJ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ N ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes EjeNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Ej'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [21 o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
bNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
<0 ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
NA
gNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections�Js Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ _
Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412015 Continued

Facility Number: jDate of inspection: '7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D'No NA ❑ NE
the appropriate box(es) below.
Fj Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No P ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
✓ l C (�9 - l
M
El Yes
ff No ❑ NA
❑ NE
Yes
No ❑ NA
❑ NE
Yes
a No ❑ NA
NE
Yes
No O NA
NE
Yes NA � NE
❑ Yes�No�NA [:]NE
Yes Er No ❑ NA ❑ NE
Phone:
Date: Z r0 /%
21412015

for Visit:
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
O Complaint O Follow-up O Referral t) Emergency O Other O Denied Access
Arrival Time: Departure Time: County: Region:
Owner Email:
Phone:
Facility Contact:
Title:
Onsite Representative:
/�
5v ''I
Q� l
I t
(a S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 7(
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design C-urrent
Cattle Capacity Pop.
DairyCow
DairyCalf
eeder to Finish
2q v
DairyHeifer
Farrow to Wean
Farzow to Feeder
Farzow [o Finish
1) . P,oultr,
Layers
Design
Ca aci
Current
P,o P.
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field O Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Iwo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes FZ ❑ NA ❑ NE
Yes No ❑ L_I ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: 'Z
Waste Collection & Treatment
4.1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ff No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes � -
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes V
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �- �--�J' o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DINO
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ej No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Qo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�j No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other•
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ W ther Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 19J - ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: - 23 / I Date of Inspection: !P"
24:Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NAB❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E5 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes go DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
'7
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
7
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[2 ""
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
[o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�❑
NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or;any other comments.. I
Use drawings of facility to better explain situations (use additional pages as necessary).
G4�"�— �991Y lj �po E
r�Cr 3 lJal, 'Py/C'
Cleth t,-I FL, je�l,, sp�c,ul�s� c�6-c,t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
5�2
Phone: 1() 114 4 7 3'Q
Date: ' Z 1(' 1 b
21412014

zz
(Type of Visit: QrCom nee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other n0/( Denied Access
Date of Visit: > o / Arrival Time: P P Departure Time: % 3 J County: v Pl r r\ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
pel-e & tJ rO b—n
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 2164;`361
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry P,oul_, C_a aci + P,o ,
Layers
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other I I
—TurkeyPouets
Turke s
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ - o [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes El ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 3 2-11 jDate of Inspection:
Waste Collection & Treatment
4 'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [-]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 011o�EI NA
❑ NE,
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ONo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes Q'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes to❑
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �
❑ NA
❑ NE
maintenance or improvement?
/—
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Ea-Tqo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes,-Ef'Nb
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [],No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0-Igo
❑ NA
❑ NE
Required Records & Documents
��
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ L_I Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 4EJ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
2). Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 2-2,el jDate of Inspection:
24. DiU the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes L3-15I6­❑ NA ❑ NE
❑ Yes ❑ No EYZA ❑ NE
❑ Yes ❑'?To ❑ NA ❑ NE
❑ Yes f No ❑ NA ❑ NE
❑ Yes 25No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ,0'19E
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ENc ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes J!j�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Date: 3 ,' o /C
Page 3 of 3 21412015

22
Operation Review (.) Structure Evaluation
Reason for Visit: C5 Routine 0 Complaint Q Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Eq�4 I Arrival Time: p, Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: y/ Q ie h Of oyn
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator.
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
]Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
2.11,0 200p I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Dq P.oultq
Layers
Design
C•a aci
Current
$o .
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
—TurkeyPouets
Turkeys
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Ej Yes Ea.No NA NE
❑ Yes No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
Yes No NA ❑ NE
Yes [� No NA NE
Yes [[�o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 2 2
Date of Inspection: 7 S—
if
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Ca<o ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes EEj<lo ❑ NA ❑ NE
❑ Yes E:rNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes QdTo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ffo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ 'o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [i No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 02" 1Vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes D-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
[i No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes , No ❑ NA. ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did. the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EINo ❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - '22
Date of Inspection: 9
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
PNo
o NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
EINo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
�IE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[]'No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
IEJ too
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
/
I__I No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gt
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑Yes
NA
❑
❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any,othercomments..
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: (i�� L (4 ✓�� Phone: 9 I 79 G 23 D 9/
Reviewer/Inspector Signature: Date: Q
lz
Page 3 of 21411015

Type of Visit:
ompliance Inspection 0
Operation Review 0 Structure Evaluation
0 Technical Assistance'
Reason for Visit:
eRoutine 0 Complaint
0 Follow-up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit: {� 0 Arrival Time: � Departure Time: � County: l: M ll \
Farm Name: D 16 / V In.�/'S�.n J Owner Email• �'7"�—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Region: VA0
Integrator:
Certification Number: a D14
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
iLayer
Design
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult
Layers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
IBeef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes g No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ETNo
❑ Yes 6 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: 2 1 jDate of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[:]No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
.0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
71 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Y No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
r-
17. Does the facility lack adequate acreage for land application?
❑ Yes
V' No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design []Maps [:]Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
Pagel of 21412011 Continued

b'acili 3Vumber: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Zr No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 01 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes f5No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [I No ❑ NA ❑ NE
❑ Yes [;/j No ❑ NA ❑ NE
❑ Yes
E6No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
VJNo
❑ NA
❑ NE
[]Yes
�'No
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better exolain situations (use additional oaees as necessarv).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: J jbS 1 vI7�AL� Date:
Page 3 of 21412011

(Type of Visit: (Z5 Compliance Inspection 0 Operation Review 0 Structure Evaluation U Technical Assistance I
Reason for Visit: (2Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �,��t Arrival Time: Departure Time: County: oj*�� Region:
Farm Names /V w(sQM.a. y9) Owner Email:
V
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number:
OL 3b 2
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I ILayer
Design
Capacity
I
C+urren[
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Dr, P,oulh,
Layers
Design
C•_a aci_
I
Current
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Tur ey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes PTNo ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
[:]Yes e No
❑ Yes ETNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 21412011 Continued

Faciti • Number: _J�. jDate of Inspection:
3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
/VNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
1Structure
Identifier:
Spillway?:
Designed Freeboard (in): 1q.5
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
7 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Fi No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
_,fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
FT
❑ NA
❑ NE
maintenance or improvement?
Waste Aoglicatioq
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[no
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®'Flo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ,PfrNo ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facili Number:S I - WIDA I Date of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 16'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ff No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CZNo ❑ NA ❑ NE
Other Issues -
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes F ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes OfNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Vr No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Vj No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
-❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑"No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
()�,< 'V.rvCyN c19_f.el-eke, .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�C.>d
Date:
2/412011

(Type of Visit: (9.Compliance Inspection V Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: �& Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �� Arrival Time:® Departure Time: County: Region:
Farm Name: �`r �,12SE 1Rl l SI T<Cd(_�� Owner Email:
Owner Name: zo/vac-D (2gLe2,VQQL,0N Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Y_ /'j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
C rQRN
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,ou_Itr
La ers
Design
C+_a aci_ +
Current
P,o ,
Cow
on -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
113cef Brood Cow
Other
El Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes b�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ,,,,,,���..❑{{{{{{......,,,, No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Faciti Number: Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IlV No
a. If yes, is waste level into the structural freeboard? ❑ Yes /❑� No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
/-Ll
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes X No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ���[[[
9. Does any part of the waste management system other than the waste structures require ❑ Yes �f \I No ❑ NA ❑ NE
maintenance or improvement? �
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes t6 No ❑ NA ❑ NE
❑ Yes No
❑ Yes 9:0
❑ Yes y No
❑ Yes I J�No
QWUP ❑Checklists QDesign E] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ''❑""" """��/Yes N No
Waste Application ❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ yyaste Transfers
❑ Rainfall ❑ Stocking ❑ op Yield 0120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -999-1
Date of Inspection: / /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
I�(I No ❑ NA ❑ NE
rjp7y�� No ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes ❑ No P NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No 1
❑ Yes K I No
❑ Yes ' \ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes NoN❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.,,,-,.3 -I
Use drawings offacility to better explain situations (use additional oaees as necessarv).
CA(1g(z4T)on/ lbue a©/a
Nv �XxmP„qc S/,� c� ► o%v� �
A � aC�l of cA�tD-rt+1S
�%IEED P i10c �ttiS
� � Q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C_f,lt.L_. I
Phone: I�dtp�pt�
Date: p(' f k a
21412011

n io( Division of Water Quality
Facility Number d O Division of Soil and Water Conservation /
O Other Agency V
Type of Visit Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )&Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 3 a // Arrival Time: � y Departure Time: � County: iN Region:
Farm Name: 'L4gSNiAW SEED 517_6*0 ( J-4S Owner Email: I1� n
Owner Name: 1�O�t A D taiL� _Q6LOLA—W Phone: go-D8 t'(P
Mailing Address:
Physical Address:
Facility Contact: (� Title:
Onsite Representative:�c2��
Certified Operator: V_yqAC.1--.'
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude:
Phone No:
Integrattoor:: /
Operant Certification Number: cal to63 (P
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
�g(o� I JLJ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude: =o=, =
Design Current
Cattle Capacity Population
E]Dairy Cow
❑ Dairy Calf
E]Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes y No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
No
El NA
[I NE
El Yes
..rr❑
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

FacilitrNumber: 71 —
Date of Inspection 1 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
/
Identifier: t�460cyy
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 %
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes /\ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes - No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) (((
9. Does any part of the waste management system other than the waste structures require ❑ Yes �jJ No ❑ NA El NE
maintenance or improvement? / \
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? \
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) / \
❑ PAN ❑ PAN > 10% or I0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ] No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 10 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ElNA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain.any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of - I2,28104 Condnued

Facility Number: — Date of Inspection 1 f�
Required
Records & Documents
"
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes )kNo
JTTT[XNo
El NA
[I NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
❑ NA
❑ NE
the appropriate box. ❑ WUP Q Checklists 0 Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
o
❑ Yes K—N
ElNA
ElNE
ual Certification
0 Waste Application 0Weekly Freeboard ElWaste Analysis 0 Soil Analysis Elj/aste TransfersryWeather
0 Rainfall [I Stocking El Crop Yield El 120 Minute Inspections 0 Monthly and 1"
ain
RInspections
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes V No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes 4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes _KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
No
❑ Yes 34,[,
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
,
❑ Yes �'J No
❑ NA
El NE
and report the mortality rates that were higher than normal?
,
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
00
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
Page 3 of 3 12128104

IType of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: "F+�•-`%' Arrival Time: t6 Departure Time: [� County:
Farm Name:
Owner Name:
Mailing Addr
Physical Address:
Facility Contact: Title:
Onsite Representative: MaQ-7 u7-Z A9_1t t,
Certified Operator: TIN �,7zyi? i s
Back-up Operator:
Location of Farm:
Region:
Owner Email:
Phone: 9 jai- 9q&-1 /A S)
Phone No:
Integrator:
Operator Certification Number: o[ 55G E
Back-up Certification Number:
Latitude: [=o =' = Longitude: =o =
Design Current
Design Current Design C•unrent
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer ❑ Dairy Cow
CK Wean to Feeder by
I ILJ Non -Layer I
Dairy Calf
❑ Feeder to Finish I
Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai -
ElN Layers
❑ Farrow to Finish
❑ Beef Stocker
❑Non -La Non -Layers
El Gilts
❑Beef Feeder
El Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�jNo
❑ NA
❑ NE
❑ Yes DNo ❑ NA ❑ NE
12128104 Continued

i
Fiicility Number: —'a
Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LArn U)j
Spillway?:
Designed Freeboard (in): i-
Observed Freeboard (in): CQ 6�__-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes )] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes V No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the smctures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) QQ J) u e a T- J s Se
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes A No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
W Yes ❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'ANo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/orany recommendations or ao'yrother corn ents� .
Use drawings of facility to better explain situations. (use additional pages -as necessary
kT WC00,6 DC) 10 o1C cPcL TJ )SAC710E
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12126104 Continued

Facility Number: 3 Date of Inspection T Jb
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box. El WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
j,C,
El Yes 111 No
`❑
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑Xaste Transfers Onual Certification
El Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and I"
Rain Inspections _ ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 'VNo
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Jp 4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
kNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes V No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes 141 No
A
El NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ANo ❑ NA ❑ NE
Piddthonal;,Comments;aud/,or�D�r rags:
pr�oTr � w. A . wAs p►cEAI 1 de w�EIL 1�1, �1�1 0 - �Utv�Q��vG FQ
R-&Mrc% G0R_ ll``��tt,,C� AA. A- W. A
. A . LOc)��S R6, (Le (3 R F TES
(kPt,ttKPlNti �`U�IT
t) c RT A5_T Lk? �� � — K Ef✓� AN ��6 T OuGSZ TEE NET
wceK. )r- Ca_o�> V-Pic.S, To p(A ov✓ p64s_Juan
i C- .�Mp 0/4 rN_)as,.tAac - pm&,,u DmGjv r 76 wLkP
WAL171�rl

Type of Visit _19(I/Cv�tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
J&
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g� Arrival Time: Departure Time: County: N Region:
1 ' Farm Name: M1 '} m rWLPAS Owner Email:
Owner Name: M aQ:Tu' A2% Phone: Ci j0' �)q 2-'Llas I
Mailing Address: I L4 I Ck...w U Q E(ALiq U I (.L—E NC O p 519
Physical Address:
Facility Contact: Title:
Onsite Representative: QiTt-1 l �Llz�fl2�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: m o m ' m Longitude: [7° [ --- 1,
[ --- ] «
Design Current
Design Current
Design
C•ucrent
Capacity Population
Wet Poultry Capacity Poulatt
Cattle
Capacity
Populatin
to Finish
❑ La er
❑ Dai Cow
n to Feeder
j Oct
❑ Non -La er
❑ Dai Calf
er to Finish
❑Dai Heifer
w to Wean
Dry Poultrw
to FeederNow
to Finish
ytiverl
Beef Stocker
N
ersPullets
❑Beef Feeders
hers
Brood CoTurke
s
❑ Turke Poults
r
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes I 'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
'qNo
❑ NA
❑ NE
❑ Yes
JQ1f-Jo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility NuDate of Inspection 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: "CCON
Spillway?:
Designed Freeboard (in):
—q
1 • S
Observed Freeboard
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes $dNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 4No
ElNA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [--]Yes MNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,RJNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
14 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
X No
❑ NA
❑ NE
(4rAaA(0j4 POTCYFAL -TU Cs>fh E OUT
CAu �Tl t�+t/
non9 0lc c-40,, NUT 5 6//7- t e7j— - ue_ti ';?> 193 NA4" & I zaz A9-D At 7
Reviewer/Inspector Name I I Phone: `]/0"t7(D" 1,5
Reviewer/Inspector Signature: 1 • Date: 1186/Q 41
v oo 7 �r x 12/28/04 Continued

Facility Number: 1 —DD9 I Date of Inspection I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Cl Yes Ex No ❑ NA ❑ NE
El the appropirate box. ❑ WUP Checklists ❑ Desig
n ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
Q Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Yaste Transfers ❑ *mual Certification
El Rainfall El Stocking 0 Crop Yield ❑' 120 Minute Inspections El Monthly and V Rain Inspections [D Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VX No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
A Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
%No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
b°t NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
jj No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
F1 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,,..,,
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
6No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D .No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a
Page 3 of 3 12128104

yt Division of Water Quality /
Facility Number 3 fpi� O Division of Soil and Water Conservation ✓
O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 19 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: -/ 3v Departure Time: County: "�_t -I N Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 9) a ARTLt 1 ,L 1 _,2ZQRT'�N
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
o = ' = Longitude: Q o = . = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design
Cattle Capacity
❑ Dairy Cow '
❑ Dairy Calf
❑ Dairy Heife
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
t<No
❑ NA
❑ NE
❑ Yes ZNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 I —&rydg I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 09 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAgoc /W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
U No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
N No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
O No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[4 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
q No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'A No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
U�No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
allo
❑ NA
❑ NE
17.
Does the Facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ft No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
a5•JCuI& ra. conp�7� '6) tt_tADr. St�RUEy /N (sOnod"S
4 S E/V O
ATTN�MANDA GA)N&S
/yC D - bw4
la-4 c4lLbiNpL DGztue Exr
LA3jL.MtJt6rCW Nc aavo5
Reviewer/inspectorName �m�)VO4 G�AINES Phone:5��—���j— 30�
Reviewer/Inspector Signature: L,i/1 ytDate:
12128104 Continued

Facility Number, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g ElMaps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
❑ Yes
01 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Qq No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
A� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LZNo
❑ NA
❑ NE
Comments and/or
JZ.(j,(n6µ%eSL Solt_ 54M?t-E Gk)ERL�t�C
OF 5-`2o7S c)N lNSt f)E OF- Dl r
i r COA17-/ t/LIC 5 /r LAN IL-t_ IV D
12128104

Division of Water Quality V
Facility Number 3 0 Division ofSoil and Water Conservation
0 Other Agency
Type of Visit 0 �Compliance Inspection 0 Operation Review 0 structure Evaluation 0 Technical Assistance Y�
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ly-/4 Arrival Time: Departure Time• County: �LZ�OZV Region: l/% Kfi
Farm Name: 5sy/m 5 Owner Email:
Owner Name: // /74' �G�ZZ� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Z&r-tl
Certified Operator: �G 8 2
Back-up Operator:
�f Phone No: Q
Integrator:
Operator Certification Number:-6�
Back-up Certification Number:
Location of Farm: Latitude: =o =, =,, Longitude: =o =, =
Design Current Design Current Designs
to Capacity Population Wet Poultry CapacityPopulation Cattle Capacityy
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Dry Poultry,
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
y Cow
Cy alf
y Heifer
Cow
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures".`..'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

. ,vl
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )2TNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 11�_/—
Spillway?: A9
Designed Freeboard (in): r
Observed Freeboard (in): t 2,5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /FZINo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes No ❑ NA ❑ NE
through a waste management or closure plan?
I
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes jd No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ���,,,{{{
9. Does any part of the waste management system other than the waste structures require El Yes y� No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'ONo El NA El NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Elf Yes I/J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J0No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes /"' No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes E] No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as,necessary):.
60,
Reviewer/Inspector Name F 1 Phone: O 72 — Z
Reviewer/Inspector Signature: Date: 73
Page 2 of 3 12128104 Continued

Facility Number: 3, —ZZ Date of Inspection 23
Reouired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
gNo
ElNA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
Pl No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
/
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
[]Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a min gauge?
❑ Yes
0 No
NA
❑ NE
23.
If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
El Yes
El No
rrr❑
, NA
u
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
0 No/
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
[I NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
1CJ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YJ No
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
/)� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
El NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
/___
32.
Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
/
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 12128104

gr Division of Water Quality
Facility Number 2'L 0 Division of Soil and Water Conservation' '
- 0 Other Agency
Type of Visit 9f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
�
Date of Visit: �j Arrival Time: Departure Time: Z.'r70 County: 00CZJ Region:
Farm Name: 4 ZD le,54-RIn S Owner Email:
Owner Name: „177.4z2i7 GZ ZZ42l) Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:=�Qp LrZ7doe /)
Certified Operator: a
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , Longitude: = o = , =
Design Current ` -
-Design .Current Design Current; _.
_
Capacity Population WetPoult
Card FCa.., o.>p'�anaCs
Capacity Population eSwrne
El Wean to Finish
. ❑ Layer
❑ Dairy Cow
?kWean to Feeder
� ,
Zf300 ' ❑ Non -Layer
C El Calf {
Feeder to Finish.
❑ Dairy Heifer
ElFarrow to Wean
Dry, Poultry
-. ❑ D Cow
❑ Farrow to Feeder
❑ Non-Dai
(i ❑Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -Layers
i'
❑ Beef Feeder
r. El Boars
'�` El Pullers
1
❑Beef Brood Cow
—
Other
- ❑ Turkeys
-
` ❑ Turke Poults
- --4 1
. � '' ' *00
., , -� ,
❑ Other
�; ❑ Other
Number of Structures
Discharges & Stream IroDacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
[]Yes
❑ No
❑ Yes
� No
❑ NA
❑ NE
El Yes
YNo
❑ NA
❑ NE
12128104
Condnued

i
Facility Number: 'Jj — Z291 Date of Inspection I /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: A/0
Designed Freeboard (in): /q,5
Observed Freeboard (in): 440 rat
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes y� No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes eV
I No ❑ NA [INE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes "No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /� No [INA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��//
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes w No El NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �INo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soiltype(s) -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes L2rNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes /E No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
105 .Sou
�ie'4 --/ F --,6
ho l r�O GZAi764 /ac
IReviewer/Inspector Name f'9A 96 JPhone. t/ I
Reviewer/InspectorSignature. Date: #
Continued

Facility Number: —Z2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10
�V No ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes y� No []NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No �dNA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [/No ❑ NA ❑ NE
❑ Yes ❑ No [PINA ❑ NE
❑ Yes 9 f No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
m No
/®
El NA
❑ NE
❑ Yes
No
ElNA
❑ NE
❑ Yes
;dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
,gE ,00N6 By OCT
Page 3 of 12128104

IType of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit o Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
99
Date of Visit: ui Arrival Time: ; Departure Time: ;
Farm Name:
Owner Name: 44It✓�
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _94&—z_q =4919
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
County:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = = a Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
p ❑ Layer
?G�� !— /&V 1 ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 17-1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes
❑ NA
El NE
,,,�////No
El Yes WfNo
❑ NA
❑ NE
12128104 Continued

Facility Number: —22 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: T/
Designed Freeboard (in): tr79/=
Observed Freeboard (in): J4V
5. Are there any immediate threats to —the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes I/J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes t� No
❑ Yes /0 No
❑ NA ❑ NE
❑NA FINE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes V1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
1p No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )Z No
❑ NA
❑ NE
�Jv/r1�' 7C O,OF/`�T COa tRDL NFL-0FO. I�/Q�O%�
!O �FFf SOCtjif Gf}�.00� <NN�Q_ fN �KL
Reviewer/InspectorName { Phone:—SyS—TiOOX.�
Reviewer/Inspector Signature: Date: O
�� 12128104 Continued

• Facility Number: — 2 Date of Inspection
Required Records & Documents ,_.,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes VJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes t,q No ElNA El NE
the appropirate box. ElWUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield yr 120 Minute Inspections 9 Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
VrNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
toNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
❑ No
JZ NA
❑ NE
❑ Yes .11Z No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[I NA
❑ NE
El Yes
,1((No
No
❑ NA
❑ NE
20) W4P /vf,F-.DS Go 66 Z.f,(Z7:--7-76N Fj� `S/ORGL C7t&jL,V a9JAP
C'RoP �300.e� A4911) /Pi4TF� eleaQE^�iu(
i20�(�,sPFC7Zv�,
11%F,0hO, CS4,1e 0vNF-,- C'ooy P,4
F012111. / nn
' (t)174: , �/16FO CROI� �SF_cp ��COQOs
/�z
12128104

Type of Visit PS'Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time: Qb
Facility Number 'L2
O Not Operational O Below Threshold
fiOermittedXCertifred 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ..... M �:_M...r.AWNS.............. County: ...... ►veltm.)..................... _._._ .._._------- _
Owner Name:
!Mailing Address:
Phone No:
Facility Contact:__._._.___._._......._._._..._......_..._..__......._...Title:............. _. . Phone No:
�/� can tI Q� n �......_.................._..._......._._./� ,o o n� c __....._._.__......
Onsite Representative:..-t'.Yi��..V--Z._�..��u...._._...._...._........__._.. Integrator:---__Si�.�tw...4,- I ..._.......-..
Certified Operator:.--........................................ _.....
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' ="
Destgn;``'Current"
Destgn urrent " Design Cdiient
C
Swme
Ca an .:Po elation. -Poultry:. .. _
act -Po nlahon =:Cattle_ _ `v Ca"aci Po ilahon._i
❑ Layer
❑Dairy
❑ Non -Layer
,'� ❑ Non Dairy
❑ Other
Total Destgn,Capactty
---
:Total SSLW V-
-
a _
Nwuber of Lagoops
Solid
Tfatis
Wean to Feeder
2 O
�
Feeder to Finish
Farrow to We
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )ZNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........... /.... ............ _..........................__....._._..........._....---••---•---•—....... ..... .- —.........-
Freeboard (inches): �-
12112103 Continued

Facility Number: ` — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
Q No
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
8.
Does any part of the waste management system other than waste structures require maintenan�mprovement?
❑ Yes
�T "
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
_
p No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenancelimprovement?
❑ Yes
p 14
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type C W
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
��-���/� �
NO
UK
Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
[ 1 N9-
15.
Does the receiving crop need improvement?
❑ Yes
EffNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[TNo
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[IE Yes
/
No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
O� /NNo
13<0
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
21No
Air Quality representative immediately.
Comments (refer to question #) ^ Mphpn any YES answers and/oc,any recb ndattous or any other comments.-
Use drawings of facdtty to better expbtm sttua6ons (use addthomtl;pages as necessary) ` : s0 Field Copy E] Final Notes
_
cid "UM o
013� fJEC-.D we�.�,�Y F�Eg�afw �aosacs . JEGOND T' EGTIoN I,.rzt}{6t7i u�OASE�
KEA�NGs,
�SE(pS AND 'PAEJA Mfi9JTAOO�
Reviewer/InspectorName .6{�11'� _ ` Tj
Reviewer/Inspector Signature: Date: 3 a.t{
12112103 Continued

Facility Number: 3 -O Date of Inspection
l
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
[IYes
❑ No
22.
Does the facility fad] to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
dNo
23.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ Waste Application eFreeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
p No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
13No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
p No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Additional'Co and/or Drawings
12112103

:2
of Visit P Compliance Inspection O Operation Review Q Lagoon Evaluation
for Visit 9fRoutine 0 Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: E
Permitted [3Certifi4W 0 Conditionally Certified 0 Registered
Farm Name: A fA- kllh e
Owner Name: _Y ZZ 4/%
Mailing Address:
Time: o�
Date Last Operated or Above Threshold:
County: "0_W/ W
Phone No:
Facility Contact: q
/,ZZ7 Title: Phone No:
OnsiteRepresentative: Integrator:QQ�GL
Certified Operator:
Operator Certification Number:
Location of Farm:
r
Swine []Poultry ❑ Cattle ❑ Horse Latitude =• =, =" Longitude =0 =, =_
,. ,.';. Design
Current. - Design Current.
Design Current
Swine Ca achy
1'o ulation Poultry Ca aci P,o ulation
' Cattle,.Ca achy P,o ulation
Wean to Feeder
❑ La er
❑Dai
El
Feeder to Finish
,. ❑Non -Lover
❑Non-Dai
_
❑
Farrow to Wean
❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish
Total Design CBpaClty
❑ Gilts
❑ Boars
Total SSI W
Number of La oons g
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps
_
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): L/U
05103101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
XNo
❑ Yes
PNo
❑ Yes XNo
Structure 6
Continued

Facility Number: — 2 Date of Inspection 2 /
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
4 No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
/
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
jT� No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
pr No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Anolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
7(No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
VNo
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
PfNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
PINo
b) Does the facility need a wettable acre determination?
❑ Yes
ONO
c) This facility is pended for a wettable acre determination?
❑ Yes
ONO
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
El Yes
VJ No
Required
Records & Documents
///���
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
A'Yes
/—
[I No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
PNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ElYes
ONO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
FfNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
04!110
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to quesho ,n E it any S answe�rs an�o�.any recommend hens or any other com ents.,. �,`„-
4J a drawmgs:a Mi ility tto`better essary`
ezplam sttuahons use addrtr al pages,asyn ce )
•=; _ ,�, , , �_ '�.._ Field ❑Final Notes
�� FrD v OCR>� E'2T2FzC/t�E �F OdF�� si/D
/�E/1/r►Z�, 1 LEF% C/_10/o %
fq) WFF/'kFF/9 UFe;kz,y
Reviewer/Inspector Name:' '° o- 7 i7:
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — Date of Inspection / O Printed on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
V(No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
VNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
VNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
J
I .f No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
VNo
5100

lAviston of Wrter Quality
e' O Division of Soil attd Water Conservation
Type of Visit )q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit k Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: —a "'O Time: �( 5
O Not Operational O Below Threshold
13 Permitted XCertified E3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: 1`\k�✓�v................................................................................ County: ._Y.^t?�th
Owner Name:
Facility Contact:
Title:
MailingAddress: .....................................................................................................................
On site Representative: (0L.1-.2:✓...............................................................................
Certified Operato!
Location of Farm:
Phone No:
Phone No:
................................/......................1.............................. ..........................
Integrator:...Lv Q.\j....................................................
Operator Certification Number: ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��•
Design Current Design_ Current Desigo Current
Swine. Capacity Population Poultry Ca aci Population Cattle Capacity, Po elation
Wean to Feeder �6 O - ❑ Layer ❑Dairy -
"�
❑ Feeder to Finish 10 Non -Layer I Non -Dairy
'; .
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
JU Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Sproy Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imoactti
I. Is any discharge observed from any part of the operation?
❑ Yes
,XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
kNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
kNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5100
Continued
on back

i
Facility Number: 31 —.51DW Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?
12. Crop type
❑ Yes 9No
❑ Yes Cg�No
❑ Yes ONO
❑ Yes ONO
(Yes ❑ No
❑ Yes 9No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes R No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: i`Vti•viola(totis;oe def►c..... i........ dirrttig ihis;visit; You will i ebeiye titi further
.�:�coriesnotideitce:abouthisvisit:�:�:�:�:�:•:•:�:�:•:•:•:�:�:�:�::�:�:�:�:�:�:�:�:�:�:�:�:�:�:•:�:�:•:•
❑ Yes ONO
❑ Yes P No
❑ Yes El No
❑ Yes KNo
❑ Yes t( No
❑Yes LffNo
❑ Yes KNo
❑ Yes XNo
El Yes Ca No
❑ Yes l�CNo
❑ Yes 9No
❑ Yes tNo
❑ Yes 0 No
❑ Yes gj No
Continents (refer to question #)i Explain any YES answers and/or any recommendations or any other comments "
Use drawings, of facility to better explain situations. (use additional pages as necessary):
I S low , I _�n t I ` r �`
q> L�� \ Ham✓ ev L�(�1 �d A. 150' �C t� 1��Ic` ATat dlK2 ti�CV vt�rtli,'
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

1
Facility Number: `3 — Date of inspection printed on: 10/26/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
PIo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
J No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
WNo
Additional Comments and/or Drawings:. ,
+
CyVe��5� 1490-
��, Y)L'1\ v>, tt wi mac\ qc�S t c�
c>-cet-
5100

Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit %Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
I Date of Vki tc
�/ 22
Permitted q Certified (] Conditionally Certified E3 Registered
Farm Name: M �q r S
OwnerName: ....._�_A.f ................... �'....2.�.........................................
Facility Contact:
Mailing Address:
Title:
Ci OD 'time: t't{ 30 Printed on: 7/21/2000
Q Not Operational' Q Below Threshold
Date Last Operated or Above Threshold: ........................
t
County:... V f"'p _I_!.:. .......................................................
Phone No:
Phone No:
Onsite Representative: ......mn 7l....... I �.ZLq✓............................................. Integrator: ..... C.- ft. I' .S
Certified Operator: ................................................... ............................................................. Operator Certification Number:.......:..................................
Location of Farm: _
swine LJ Pounry LJ uatue LJ Norse ---
Design Current
Swine Cavacity Population
Wean to Feeder
2q(00
2q(o
0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
[]Gifts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
No Liquid Waste
Area J❑ Spray Field Area
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated Ilow in galhnin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Suvcture I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................ I ............... .... ............... ..................... ................................... .................................... .............................
Freeboard (inches): 3%
5100
❑ Yes 0 No
❑ Yes No
❑ Yes No
VIA
❑ Yes 0 No
❑ Yes JO No
❑ Yes M No
❑ Yes 0No
Structure 6
Continued on back

acility Number: 31 — Date of Inspection 8 2t} 00 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
❑ Yes No
❑ Yes N No
❑ Yes P No
❑ Yes �? No
❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Yes ® No
12. Crop type COr'r1 J t,/tje0i4 -50V be. ,s GrYt;'X
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes '19 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0' tVd violafititis:oT deenci8s were noted dueipg this:visit*.-You :will i eceiye tio: further; ;
corresuotideitce:abotitthis visit_ ::...::............................ .
❑ Yes ❑ No
J4 Yes ❑ No
❑ Yes PdNo
❑ Yes KNo
❑ Yes F1 No
❑ Yes Ad No
❑ Yes JR No
❑ Yes JS No
❑ Yes ($No
❑ Yes �0 No
❑ Yes tgNo
❑ Yes § No
❑ Yes OfNo
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
l�. r"'iJ 14M ;S-ro-oad ?Coe ljeA11.0C ncee �¢-�-Lt �;'1/�I -l'iOh HgVG dd� 'w�;4 rke"
/col A�A Seh61 ✓ie q eOr �e�er�M��,oI-/�ol�/Yv1Ap shewl�,,ryry 9v1/s�
iA hOl t,.,OAe pla', wr;><Ie •, base on �re�{ed acrQs. St,b,wi-�_w il•� 6%
S2�/-i�e•,6er ;jet 200d -ip: S{oyleWy)l 61a04is 1z7 CA-d;nqI Dr, CW
11, N�L+ WAs- e gllglysis is needed. So;1 -Fes} heeds 0 6e iv) records.
1Pecd.-• iehi( 5-ow, �i29;h keeping weekl� �iree6oerd IcOorGlS.
Reviewer/Inspector Name—570)jewed l ✓ td k ;J
Reviewer/Inspector Signature: C ��li•cDate: Yl4T/yt/ 5/00

Facility Number: Date of Inspection 2 DO
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
P(No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Jj No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
C6 No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
D4 No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
P9 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
M No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
1�4 No
Additional Comments and/or Drawin - 'r -r r . , -
3/23/99

V
0 Division of Soil and Water Conservation Operation Review r
Division of Soil arid Water Conservation Coin 16 a Inspection
f , Division of Water Quality Comphance Inspection
Other Agency -Operation Review
J® Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number 3 I ZZ Date of Inspection 0
Time of Inspection 24 hr.
Q Permitted P3 Certified 0 Conditionally Certified 0 Registered Not O erational Date Last Operated: ..........................
FarmName: ... .............. i1�i°}.ML .......F .Y..1............I................\.......................................... County: ...... I...tJ......................................... .......................
Owner Name: .................':!*'D! ' _N' ......................... t�.11.Z..'ZksYd......................................... Phone No: `Il()%�.Zvig..-............................................
FacilityContact: .............................................................................. Title:.....:.......................................................... Phone No:
Mailing Address:...... 7-0.q.61..... .:...NG... SJ�...1 �........ 4M0.4V..SA)J�................bA.............................M..`.1........
Onsite Representative:.........utbf..�.....1>.f.aLzIJ................................................ Integrator:........ ........................................................
Certified Operator: ................................................... ............................................... ............ Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =1 Longitude =0=' ="
c
'Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑Spray Field Area ..
Holding Ponds /'Solid Traps � ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gaVmmT
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
❑ Yes M No
❑ Yes V No
❑ Yes E� No
❑ Yes [P No
❑ Yes [M No
❑ Yes [21No
❑ Yes W No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard(inches): ..........3G............................................................................................................................ ...........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes W No
Continued on back
3/23/99

Facility Number: 31 — 229 Dale of Inspection I 10h VIA
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes P No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? []Yes .® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Aoolication
10.
11.
12.
Are there any buffers that need maintenance/improvement?
Is there evidence of over application? \❑ Excessive Pending 0PAN
Crop type .Orn Lwkt..' soj wa,==;l S 1n",
❑ Yes
5PYes
® No
Ol No
13.
Do the receiving crops differ with those designate4 in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
R No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15.
Does the receiving crop need improvement?
Q Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/-irrigation, freeboard, waste analysis & soil sample reports)
50 Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
to No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
MNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
U. di �Vdyiolafiotis:oi•def►ciencleswer8noted•teifidthis:visit:'1'ou. i11�iebeigeriofu,ki r
correspondence: ab6uf this visit:
Comments {refer toquestion Explain any YES answers and/or any. recommendations or aottier coenmmts
.. _. .. ny ..
Use drawings of facility to better explain situations. (use additional, pages as,necessary)2: -
!S Carn S�v1J e rct�ove cl os seen Cons "nnz allow• q, 5
ply-t-J aSsue,. A� poss�b�-•
W. A IRR--Z %rrr� 'S�v� lee ll�,F ier eaa, G•rop- (Avcl/odor ca,W 4-
.Y'^OrE9•�� LI.,iGI� lis-k Siva%lyr �e C, VtCOrbS.
0. OJereePGcfe{io. o% NI�rnSw ot• p���S I A * 18 '�ff%�6S�ac e•.
zY, Some �ov�e� t.Ja5i- ®6swed rimer rfcl v,vrP] Sir Fran taas:e rz1�i11itaj1aN rvho
Reviewer/Inspector Name ri a r
Reviewer/InspectorSignature: Date: lokyw
3/23/99

FacilityNumber:%qq
1 — Z'L Date of Inspection Q
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[� No
roads, building structure, and/or public property)
29.
-Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
PNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover? -
❑ Yes
�d No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
;&No
3/23/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
IRRoutine UlComplaint 0 Follow-up of DWQ inspection V Follow-up or DSWC review V Other 1
Date of Inspection to A
Facility Number 3
Time or Inspection 7o�j ?A hr. (hh:mm)
0 Registered q Certified E3 Applied for Permit E3 Permitted 113 Not Operational I Date Last Operated:
FarmName: ................ JAJJ...... jjj�ft.................................1........................................... County: ........ .s1P�!.........................................................
Owner Name: ........ _............... A4y........ .... kJaz,..V�J........................................... Phone No: �A10�79$.....kZS............................................
FacilityContact: .......................................................... .................... Title:................................................................ Phone No:...................................................
Mailing Address: ......lgi...... N....��iLza ...To?.tn..... i�A .:........................................... N.C..................................... .z2 ytv........
Onsite Representative:.......... M.ar,lj.........11;ZZaYA.............................................. Integrator:.......C.4.-.Y"..4 5.......................................................
Certified Operator:............................................................................................................... Operator Certification Number:
Location of Farm:
Latitude ' =' =11 Longitude O. O' 0"
Desrgns: „Current -_,Design° _Current" Design 'Current ;
Somme : Capacity`Popolatioitr'. Poultry ! apacity,l'opulation- = Cattle'- Capacity Population,;;
K: Wean to Feeder 2, p ❑ Layer ❑ Dairy
Feeder to Finish ; _ ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
-:❑ Gilts
. '
❑ Boars Total SSLVY
Number;of twns7 Holding Ponds' ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area ;
>� 0;
b yi
s y vy ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes EN No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes EA No
c. If discharge is observed, what is the estimated flow in gal/min? N I�,
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ) ❑ Yes Y' No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ( No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

Facility Number.
8. Are there lagoons or storage ponds on site which need to be property closed?
Structures (LaQoons.Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard(ft):..............54iL.............
10. Is seepage observed from any of the structures?
❑ Yes• (P No
❑ Yes 00 No
Structure 3 Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markets?
Waste Aoolication
❑ Yes I?No
❑ Yes No
❑ Yes Qj No
❑ Yes [N No
14. Is there physical evidence of over application? ❑ Yes .] No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) l
1 yL
15. Crop type ................. CRF..Ic.............. wl.-.s.t..4.......... .-.................. �tbzj!...f�:�1.1.................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [ANo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
' No
18.
Does the receiving crop need improvement?
❑ Yes
to No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
14 No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
7
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
f
D-No.violatioits or deficiencies. were ntited during this:visit. You.will receive ito further .
correspotideh& about this:visit::
zz- Ok!w Nc a,,t c_r%1 so-+ t&". 5cs sl ec�tj be
U.4{- (vr cc c�- crap l e"A— pull,
In-z- fov — Shah L�
7/25/97
IReviewer/Inspector Name 11 X
Reviewer/Inspector Signature Date: lb

r Division of Soil and Water Conservation ❑ Other Agency x
x
t' Division of Water Quality
�*
� x
,>
Koutine 0 Com laint 0 Follow-up of DWQ inspection
0 Follow-up of DSWC review 0 Other
Date of Inspection
_••�
Facility Number 3 L2
Time of Inspection t 3 24 hr. (hh:mm)
U Registered Q Certified [3 Applied for Permit 13 Permitted
JE3 Not Operational I
Date Last Operated: ..........................
Farm Name: ........ l^h.?.k..Ni.....QQ...rAY.M.....I..........................................................................
County:......... n....................................... .......................
Owner Name:......1'!4V �?� Sl.� .-1..4ufJ
........................................................................
Phone No:...(14...24 .-.. LsI.........................................
Facility Contact:.....{.......11.N.4N.rA........................... Title: ........
Q4JnW........................................ Phone No: .... ........
Mailing Address: ..... 1 .1........N.Uk ..... ll,l.ikz� ....... AW..A.......0.......................
........9fU.6(..d.L.4..1.J5-..................................... ...2. .d..........
OnsiteRepresentative: ...... ` alcil. ...... li.Z Jc......................................................
Integrator:........_.6.P..Y."115................................................... ....
Certified Operator...............................................................................................................
Operator Certification Numbert.........i. ........
Location of Farm: -
Latitude Longitude �• �` �"
Design;" -.Current ,:Design.. -Current ..Destgn Current;
Swine 'Capacity Population- _Poultry ; Cap"acity Population Cattle . ; ,Capacity Population=
® Wean to Feeder L- G0 10 Layer ❑ Dairy
❑ Feeder to Finish _ ❑ Non -Layer I ILI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other -
❑ Farrow to Finish Total .Design Capacity,', Z 0
❑Gilts
❑ Boars ' Total SSLW"
Number, of Lagoons / Holding Ponds,._.: ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Freld Area �`:
_.
, - -.' ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is obseneed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [9 No
❑ Yes NNo
❑ Yes ($ No
❑ Yes ® No
NA
❑ Yes [jjNo
❑ Yes 0 No
❑ Yes ® No
❑ Yes jRj,�o
❑ Yes &No
❑ Yes 19 No
Continued on back

Facility Number: 31 — Z7s1
8. Are there laeoons or storage ponds on site which need to be properly closed?
Structures (Layoons,tloldine Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): .......I :?..................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application -
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
® No
❑ Yes
® No
Structure 5 Structure 6
................................................................
.................................................................
❑ Yes
R1 No
❑Yes
[9No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
15. Crop type ............. t^m:n......................................................................... L.lwa............................. _...............................
.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[A No.violati/insor deficiencies.were i►oted during this. visit. You:wiH receive no further:
.......................... .. ........ .............
correspQtidettce about this:visit.
❑ Yes No
❑ Yes ® No
❑ Yes %No
❑ Yes &No
❑ Yes JRLNo
❑ Yes RNo
(Yes ❑ No
❑ Yes l$No
❑ Yes Pit No
❑ Yes ® No
7. lia,R ccraS on I s'oen ai4 'JO SWV1d ba res"W.
7-7— 1361A CVV gt QIA be al'M M 'J"11 V4+Ii7_046n PI". Soij((�ouj wn�k SCMpt.t A*("es
3110016 `ae. V,1�a'�-(,D in 11.Icvn. use a se�&M1t lfkk-L (porn, t r e" Lvv� pIanW) aKo
Use 4tout(. Ioadtn) 1 t (oY eEAA( CWT. rm -irirybon "n "aUo be II`n ee✓f fij
7/25/97

State of North Carolina
Department of Environment,
Health and Natural Resources •
Division of Water Quality
tip•
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary ED E H N R A. Preston Howard, Jr., P.E., Director
April 3, 1997
Marty Blizzard
M & M Farms
2099 E NC 24
Kenansville NC 28349
SUBJECT: Notice of Violation
Designation of Operator in Charge
; : M & M Farms
Facility Number 31--229
Duplin County
Dear Mr. Blizzard:
You were notified by letter dated November 12, 1996, that you were required to designate a
certified animal waste management system operator as Operator in Charge for the subject facility by
January 1, 1997. Enclosed with that letter was an Operator in Charge Designation Form for your
facility. Our records indicate that this completed Form has not yet been returned to our office.
For your convenience we are sending you another Operator in Charge Designation Form for your
facility. Please return this completed Form to this office as soon as possible but in no case later
than April 25, 1997. This office maintains a list of certified operators in your area if you need
assistance in locating a certified operator.
Please note that failure to designate an Operator in Charge of your animal waste management
system, is a violation of N.C.G.S. 90A-47.2 and you will be assessed a civil penalty unless an
appropriately certified operator is designated. Please be advised that nothing in this letter should be
taken as absolving you of the responsibility and liability for any past or future violations for your
failure to designate an appropriate Operator in Charge by January 1, 1997.
If you have questions concerning this matter, please contact our Technical Assistance and
Certification Group at [phone].
Sincerely,
for Steve W. Tedder, Chief
Water Quality Section
bb/awdesletl
cc: Wilmington Regional Office
Facility File
Enclosure
P.O. Box 29535, Ni
FAX [phone]
Raleigh, North Carolina 27626-0535 N�� C An Equal Opportunity/Affirmative Action Employer
Telephone [phone]% recycles/10% post -consumer paper

Site Requires Immediate Attention:
Facility No. �? J_.__!)L_�1�
DIVISION OF ENVIRONMENTAL MANAGEMENT ✓ t ° I
• ANIMAL FEEDLOT OPERATIONS slTE vISTTATION RECORD
DATE: 1995
Time: ! 2 e �
On Site Representative: Phone:
Physical Address/I
Type of Operation.
Design Capacity: .
r
DEM Certification Number: ACE
DEM Certification Number: ACNEW
Latitude:,'1 * J_ Longitude: —77 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour stotm,event
(approximately 1 Foot + 7 inches)(Gor No Actual Freeboard: —3—Ft: Inches
• Was any seepage observed from the lagoon(s)? Yes oreCyas any erosion observed? Yes o Ido
Is adequate land available for spray? es r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: C 0 F to
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 40or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or e5
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(9T
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o<00 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
L&A -
Signature
a
cc: Facility Assessment Unit Use Attachments if Needed.

�%►'�, Site Requires Immediate Attention:
Facility No. a�
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: 12 4.7
Farm Name/Own
Mailing
gAAdd�ress: v '
County
Integrator.
*- On Site Representative: _1�
Physical Address/]
Type of Operation
Design Capacity:
DEM Certification Number: ACE
Phone:
Phone: q10
Number of Animals on Site:
DEM Certification Number: ACNEW
Latimde:34:t 6�7 Longitude: —7-7 ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 'e ?or No Actual Freeboard:. —Ft: Inches
• Was any seepage observed from the lagoon(s)? Yes orCVas any erosion observed? Yes o IVo
Is adequate land available for spray? es r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: C o f '
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Ce or No
100 Feet from Wells? 6- or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or.
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oro
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o to If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

• Site Requires Immediate Attention:
- Facility No. —
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATI NS SITE VISITATION RECORD
DATE: Z.7 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
Integrator.
On Site Representative:
Physical
Phone:
Number of Animals on Site:
DEM Certific tion Nymber: ACE DEM Certification Number: ACNEW _
Latitude:' �U� ' Longitude: 7�' Y / ' �^ Elevation: -----Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 2.4 hour storm event
(approximately 1 Foot + 7 inches) O or No Actual Freeboard: :� Ft Inches
Was any seepage observed from the lagoon(s)? Yes 010 Was any erosion observed? Yes ots
• . Is adequate land available for spray?. Yes or No . Is the cover crop adequate? Yes or No
Crop(s) being utilized: L'_!7 rf7
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or TO
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or io
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other �J
similar man-made devices? Yes or & : If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with over crop)? Yes or N
Additional Co ents:�.. G� K O/t / �P
f 1
LJ
Type of 1
Design Capacity: _
cc: Facility Assessment Unit Use Attachments if Needed.

07%1995 13:27
07/17/95 08:58
v
$9102902122 USDA \RCS
'LSH10L9621LL USDA.14RCS
Z 003
10002
JUL 13 '95 09:02AM
•
Site Requires Immediate Attention _14—
SITE VISITATION RECORD
Faciliry Number. 3 j
DATE �T I n 1995
Owner: `raao ;=o-r RAI _ (Taftzw?� Fann Name:-- 4:3o2 Lpke P;�[MS
County: IX) Pc1N l
Agent visiting Site: U eaf-L EFA-6&P1 Phone: Q10 246 -2IZC
Operator: Phone:
On Site Representative:
Physical Address: ��• c
Mailing Address:
Phone: ZS 3 — ? 4 S
Type of Operation: Swine X Poultry — Cattle
Design Capacity: ? Number of Animals on Site:
. Latitude: o Longitude: o "
Type of Inspection: Grmmd_ Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hoar storm event
(approximareiy I Foot Yf ChLs) Yes 00 Actual Freeboard: I Feet _ Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes o No as there erosion of the dam?: Yes o No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: